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Performing under pressure: cardiopulmonary ventilatory efficiency in patients with pulmonary hypertension
Session:
Posters (Sessão 5 - Écran 6) - Tromboembolismo pulmonar
Speaker:
Rita Amador
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rita Amador; Sérgio Maltês; Gonçalo JL Cunha; Bruno ML Rocha; Catarina Brízido; Christopher Strong; António Tralhão; António Ventosa; Carlos M. Aguiar; Luís Moreno; Anaí Durazzo; Miguel Mendes
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Right Heart Catheterization (RHC) remains the gold standard for the diagnosis and classification of pulmonary hypertension (PH). Recently, cardiopulmonary exercise testing (CPET) ventilatory efficiency parameters during exercise have shown to be correlated with the degree of pulmonary hypertension in RHC, at rest. However, the correlation with CPET resting parameters is currently unknown. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The aim of this study is to characterize the CPET findings in patients with pulmonary hypertension undergoing RHC, as well as the correlation between resting and exercise ventilatory efficiency parameters and RHC.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This was a single centre restrospective study enrolling patients who underwent both CPET and RHC within 6 months of each other from 2015-2022 and met the criteria for pulmonary hypertension, mean pulmonary artery pressure (mPAP) higher than 20 mmHg, as per the 2022 ESC guidelines. RHC measures used were taken at rest and without administration of nitric oxide.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 84 patients were included (mean age 56 ± 11 years, 76% male, with a median LVEF of 27 [20 - 34] %, mostly HFrEF patients being evaluated for heart transplant). The main cause for HF in the cohort was ischemic heart disease (48%, n = 40), followed by idiopathic dilated cardiomyopathy (19%; n = 16).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RHC showed mean mPAP of 38 ± 11 mmHg, and median pulmonary vascular resistance (PVR) was 3,4 [2,0 – 5,5] WU. Most patients had combined pre- and post-capilary PH (69% n = 83).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Overall, 52 patients (62%) attained a maximal CPET (respiratory exchange ratio≥1.10) and the second ventilatory threshold was identifiable in 66 (78%). Median peak-VO2 (pVO2) was 13,0 [10,3 - 15,1] mL/kg/min (corresponding to a median of 48% of predicted VO2 max) and median VE/VCO2 Slope was 46 [37 – 60]. There was a significant correlation between RHC parameters (PMAP and PVR) and CPET parameters (VE/VCO2 slope, PetCO2 and EqCO2) which was weak at rest and moderate during peak exercise (Figure 1). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a population of patients with HFrEF with predominantly combined PH, CPET ventilatory efficiency parameters showed a significant correlation with RHC indices of pulmonary hypertension. CPET peak exercise parameters seem to correlate better with RHC than resting parameters, suggesting that factors other than PH influence resting ventilatory efficiency more heavily at rest versus exercise. </span></span></p>
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